Pain Management in Older Adults

142 Pages·2018·2.19 MB·English

by  Gisèle Pickering

Perspectives in Nursing Management and Care for Older Adults
Series Editors: Julie Santy-Tomlinson · Paolo Falaschi · Karen Hertz
Gisèle Pickering
Sandra Zwakhalen
Sharon Kaasalainen
Editors
Pain Management
in Older Adults
A Nursing Perspective
Perspectives in Nursing Management
and Care for Older Adults
Series Editors
Julie Santy-Tomlinson
School of Health Sciences
University of Manchester
Manchester, United Kingdom
Paolo Falaschi
Sant’Andrea Hospital
Sapienza University of Rome
Rome, Italy
Karen Hertz
University Hospitals of North Midlands
Royal Stoke University Hospital
Stoke-on-Trent, United Kingdom
The aim of this book series is to provide a comprehensive guide to nursing
management and care for older adults, addressing specific problems in nursing and
allied health professions. It provides a unique resource for nurses, enabling them to
provide high-quality care for older adults in all care settings. The respective volumes
are designed to provide practitioners with highly accessible information on
evidence-based management and care for older adults, with a focus on practical
guidance and advice.
Though demographic trends in developed countries are sometimes assumed to be
limited to said countries, it is clear that similar issues are now affecting rapidly
developing countries in Asia and South America. As such, the series will not only
benefit nurses working in Europe, North America, Australasia and many developed
countries, but also elsewhere. Offering seminal texts for nurses working with older
adults in both inpatient and outpatient settings, it will especially support them
during the first five years after nurse registration, as they move towards specialist
and advanced practice. The series will also be of value to student nurses, employing
a highly accessible style suitable for a broader readership.
More information about this series at http://www.springer.com/series/15860
Gisèle Pickering • Sandra Zwakhalen
Sharon Kaasalainen
Editors
Pain Management in
Older Adults
A Nursing Perspective
Editors
Gisèle Pickering Sandra Zwakhalen
CIC Inserm 1405 Health Services Research
University Clermont Auvergne and Maastricht University Health Services
University Hospital Research
Clermont-Ferrand Maastricht
France Limburg
The Netherlands
Sharon Kaasalainen
School of Nursing
McMaster University School of Nursing
Hamilton
Ontario
Canada
ISSN 2522-8838 ISSN 2522-8846 (electronic)
Perspectives in Nursing Management and Care for Older Adults
ISBN 978-3-319-71693-0 ISBN 978-3-319-71694-7 (eBook)
https://doi.org/10.1007/978-3-319-71694-7
Library of Congress Control Number: 2018948153
© Springer International Publishing AG, part of Springer Nature 2018
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfilms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims
in published maps and institutional affiliations.
This Springer imprint is published by Springer Nature, under the registered company Springer
International Publishing AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Preface
The book Pain Management in Older Adults: A Nursing Perspective features theo-
retical and practical information about the assessment and management of pain in
older adults. It is written for nurses, nurse specialists, advanced nurse practitioners,
and academics who are interested in pain management in older adults.
Pain is one of the most distressing and commonest symptoms of later life. Mood,
quality of life, independence, and relationship are all affected and the high preva-
lence of pain has a substantial impact at both individual and societal level. Although
more attention has been paid to pain in older persons over the last decades, pain
remains underdetected, underestimated, and undertreated especially in the most
vulnerable with neurodegenerative disorders and communication difficulties.
Nurses care for older people in primary, secondary, and independent settings and
have been at the forefront of pain care for centuries. Nurses play a crucial role in the
assessment and management of pain. Their involvement with older persons is mul-
tifaceted, involved in pain assessment, comfort care, nonpharmacological and phar-
macological approaches, and beyond managing an individual’s pain, critical
self-reflection and service development. Nurses are deeply involved throughout the
care process and collaborate with interdisciplinary teams throughout care settings.
Nursing older people is challenging and rewarding and we felt it was timely to pro-
duce a book from the nursing perspective.
We have included chapters covering epidemiology, assessment, therapeutic
approaches, as well as chapters focused on the pivotal role of nurses in older persons
pain management.
The editors and authors have worked to ensure that these chapters reflect older
adults pain management essentials. It is our hope that this book will provide nurses
working in primary health and care social areas as well as undergraduate and post-
graduate nursing students with evidence that helps them in the caring process.
The book is an international collaborative effort and the editors would like to
express their gratitude to all the authors for their contributions.
Clermont-Ferrand, France Gisèle Pickering
Maastricht, The Netherlands Sandra Zwakhalen
Hamilton, ON, Canada Sharon Kaasalainen
v
Contents
1 Epidemiology of Pain in Older People . . . . . . . . . . . . . . . . . . . . . . . . . 1
Gisèle Pickering
2 Pathophysiology of Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Elodie Martin
3 The Assessment of Pain in Older People . . . . . . . . . . . . . . . . . . . . . . . . 31
Thomas Fischer, Erika Sirsch, Irmela Gnass, and Sandra Zwakhalen
4 Non-pharmacological Management of Pain in the Elderly . . . . . . . . . 47
Carol Mackintosh-Franklin
5 Pharmacological Treatment of Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Gisèle Pickering
6 Pain in Older Adults with Intellectual Disabilities . . . . . . . . . . . . . . . . 73
Nanda Cécile de Knegt
7 Pain in Critically Ill Older Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Marie-Madlen Jeitziner, Béatrice Jenni-Moser, Thekla Brunkert,
and Franziska Zúñiga
8 Nursing Roles in Managing Pain in Older Adults . . . . . . . . . . . . . . . . 93
Abby Wickson-Griffiths, Sharon Kaasalainen, and Laura Pokoradi
9 Attitudes and Barriers to Pain Management
in the Ageing Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Paul A. Cameron, Rebecca Chandler, and Pat Schofield
10 Translating Knowledge to Improve Pain Management Practices
for Older Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Esther Coker and Sharon Kaasalainen
vii
Abbreviations
°C Degree Celsius
5-HTR Serotonin receptor
ABCDEF Awakening and Breathing coordination of daily sedation and ventila-
tor removal trials; Choice of sedative or analgesic exposure; Delirium
monitoring and management; Early mobility and exercise and
Family-centered care
ACC Anterior cingulate cortex
ACR American College of Rheumatology
AD Alzheimer disease
ADL Activities of daily living
AEs Adverse effects
AGS American Geriatrics Society
AI Appreciative Inquiry
AMDA American Medical Directors Association
AMPA α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid
APN Advanced practice nursing
ASPMN American Society for Pain Management Nursing
ATP Adenosine triphosphate
AuPS Australian Pain Society
B2 receptor Bradykinin receptor 2
BDNF Brain-derived neurotrophic factor
BGS British Geriatrics Society
BPGs Best practice guidelines
BPS British Pain Society
BPS scale Behavioral pain scale
BPS-NI Behavioral pain scale—not intubated
BPSD Behavioral and psychological symptoms of dementia
Ca2+ Calcium ion
CAM Confusion assessment method
CAM-ICU CAM for intensive care
CaMKII Calcium-calmodulin kinase II
cAMP Cyclic adenosine monophosphate
CAMs Complementary and alternative therapies
CBT Cognitive behavioral therapy
CCK Cholecystokinin
ix
x Abbreviations
CGRP Calcitonin gene-related peptide
CNPI Checklist of nonverbal pain indicators
CNS Central nervous system
Coxibs Cyclooxygenase-II selective inhibitors
CPAT Certified nursing assistant pain assessment tool
CPGs Clinical practice guidelines
CPOT Critical-care pain observation tool
CPS Canadian Pain Society
CREB cAMP response element binding protein
CT scan Computerized tomography scan
DNA Desoxyribonucleic acid
DNIC Diffuse noxious inhibitory controls
DOR Delta opioid receptor
DQP Deutsches Netzwerk für Qualitätssicherung in der Pflege
DRG Dorsal root ganglion
DSM-5 Diagnostic and Statistical Manual of Mental Disorders Fifth Edition
DVT Deep vein thromboembolism
DZNE German Center for Neurodegenerative Diseases
eCASH Early Comfort using Analgesia, minimal Sedatives and maximal
Human care
EPSP Excitatory postsynaptic potential
ERK Extracellular signal-regulated protein kinase
fMRI Functional magnetic resonance imaging
GABA Gamma-aminobutyric acid
GP General practitioner
H+ Hydrogen ion
H1 Histamine receptor
HCP Health care practitioner
IASP International Association for the Study of Pain
ICU Intensive care unit
ID Intellectual disabilities
IPSP Inhibitory postsynaptic potential
IQ Intellectual quotient
IV Intravenous
KA Kainate
KOR Kappa opioid receptor
KT Knowledge translation
LPNs Licensed practical nurses
MCI Mild cognitive impairment
mGluR Metabotropic glutamate receptors
MMSE Mini-mental state examination
MOBID Mobilization-observation-behavior-intensity-dementia pain scale
MOR Mu opioid receptor
Na+ Sodium ion
NCCIH National Center for Complementary and Integrative Health
Abbreviations xi
NHS National Health Service
NICE National Institute for Health and Care Excellence
NMDA N-methyl-d-aspartate
NOPPAIN Non-communicative patient’s pain assessment instrument
NPs Nurse practitioners
NRM Nucleus raphe magnus
NRS Numerical rating scale
NSAIDs Nonsteroidal anti-inflammatory drugs
PACSLAC Pain assessment checklist for seniors with limited ability to
communicate
PAG Periaqueductal grey
PAINAD Pain assessment in advanced dementia
PARIHS Promoting Action on Research Implementation in Health Services
PATs Pain assessment tools
PBOICIE Pain behaviors for osteoarthritis instrument for cognitively impaired
elders
PET Positron emission tomography
PFC Prefrontal cortex
PKA Protein kinase A
PKC Protein kinase C
PLC Phospholipase C
PMN Pain management nursing
QI Quality Initiatives
RASS Richmond agitation sedation scale
RCTs Randomized clinical trials
RNAO Registered Nurses Association of Ontario
RNs Registered nurses
RVM Rostral ventromedial medulla
S1 Primary somatosensory cortex
S2 Secondary somatosensory cortex
SRD Subnucleus reticularis dorsalis
TENS Transcutaneous electrical nerve stimulation
TRP Transient receptor potential cation channel
TRPM8 Transient receptor potential cation channel subfamily M member 8
TRPV Transient receptor potential vanilloid
TTX Voltage-gated sodium channel
TTXr Tetrodotoxin-resistant sodium channels
UK United Kingdom
UTI Urinary tract infection
VAS Visual analogue scale
VDS Verbal descriptor scale
VIP Vasoactive intestinal peptide
VRS Verbal rating scale
WDR Wide dynamic range
WHO World Health Organization